Complaint Investigation Report

331800484-4-15-2023-18-AS-KCLS-CR2T2T-20230419142115

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1650 SPRUCE ST STE 200 MS29-27

This is an official report of an unannounced visit/investigation of a complaint received in our office on

06/07/2021 and conducted by Evaluator Shaunte Henry

COMPLAINT CONTROL NUMBER: 18-AS-20210607090221

**This is a copy of Original 9099 dated 6/08/2021, investigation conducted by LPA Shaunte Henry and Anna Bueno**

On 6/8/21 Licensing Program Analysts (LPA) Shaunte Henry and Anna Bueno conducted an unannounced visit in order to initiate an investigation into the above allegation. LPAs spoke to DSP, Nicole Lara, explained the purpose of the visit and were granted entry.

The investigation, which consisted of interviews and document review revealed the following:

Staff locked resident in their room. An interview with the administrator revealed that Staff 1 (S1) locked Client 1 (C1) in his bedroom because of a behavior episode while S1 was attempting to prepare medication. The administrator counseled S1 and provided training to address their actions.

Based on LPAs observations and interviews, which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

An exit interview was conducted where this report was provided to licensee/administrator John Edgington.